﻿<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">

<head>
<meta content="en-us" http-equiv="Content-Language" />
<meta content="text/html; charset=utf-8" http-equiv="Content-Type" />



<title>Untitled 1</title>
<link href="../CSS/generic_home.css" rel="stylesheet" type="text/css" />
<style type="text/css">
.auto-style1 {
	margin-left: 150px;
}
</style>
</head>

<body>

<div id="main_container" style="left: 3px; top: 6px; height: 659px;" >

	<div id ="header">
		<img alt="logo" height="82" src="../Images/logo4.png" width="294" style="margin-left: 20px; margin-top: 10px;" />
		<div class="auto-style1" style="height: 494px; margin-top: 50px; margin-right: 150px; margin-bottom: 50px;">
			<form method="post" action="">
                        
                        <fieldset name="Group1">
			<legend>User Details</legend>
			E-Mail <input class="box" name="email" type="text"  /><br />
			Username<input class="box"name="username" type="text" /><br />
			Password<input class="box" name="password" type="password" /><br />
			Retype Password<input id="box" name="repassword" type="password" /><br />
			</fieldset><br />
			
			<fieldset name="Group1">
			<legend>Personal Details</legend>
			First Name<input name="first_name" type="text" /><br />
			Middle Name<input name="middle_name" type="text" /><br />
			Last Name<input name="last_name" type="text" />
			</fieldset><br />
			
			<fieldset name="Group1">
			<legend>Address Details</legend>
			<br />
			House Number <input name="house_number" style="width: 37px" type="text" />
			Street <input name="street" type="text" /><br />
			Subdivision <input name="subdivision" type="text" /> 
			City <input name="city" type="text" /><br />
			Postal Code<input name="postal_code" type="text" /> 
			Country <select name="country" style="width: 146px">
					<option></option>
					</select><br />
			<br />
			</fieldset><br />
			</form>
			<input name="submit" type="button" value="Submit" /></div>
			</div>
		
</div>

</body>

</html>
